For years, the United States has been battling the opioid crisis. Prior to 2020, some progress had been made thanks to a variety of interventions at the federal, state and clinical levels. When the COVID-19 pandemic erupted, however, despair and social isolation became the norm nationwide.
It was little surprise that opioid addiction regained a strong foothold. During the first half of 2020, the CDC reported that overall life expectancy dropped. Although COVID-19 played a role, so did the rise in drug overdose deaths. A paper published by the Opioid Response Network noted, “The same populations already at risk [for substance/opioid use disorder] are also the people most impacted by COVID-19.”
In addition, new research suggests that there may be a link between COVID-19 and opioid addiction, as doctors may be more likely to prescribe opioids to individuals experiencing lingering symptoms of the disease.
Without a doubt, the pandemic has brought a renewed sense of urgency to America’s opioid crisis. It has also shed light on lessons that can address the risk factors associated with opioid use and barriers to treatment. Here are four things that we’ve learned:
- Expanded broadband access is needed in low-income, rural and underserved communities. During the pandemic, telehealth provided a lifeline for patients. Telemedicine, however, assumes access to broadband Internet service. Unfortunately, many areas without broadband service are also those regions that were disproportionately impacted by COVID-19 and are particularly vulnerable to chronic diseases, including opioid addiction. In a recent Stat News article, for example, Stephen Taylor, a Birmingham, Alabama-based psychiatrist and addiction specialist, noted that to get a Wi-Fi signal, “we have people who sit in a McDonald’s parking lot so they can do Zoom meetings.”
- Personalized, multi-modal outreach is an effective way to engage high-risk individuals. At the height of COVID-19, multi-modal outreach worked well to communicate with people at increased risk of contracting the vaccine. This strategy can also be applied in the context of opioid addiction. Health plans can send personalized messages and interventions to members that take into account their medical needs, as well as the socioeconomic stressor that affect access to treatment or support services. One example is increasing pre-operative education about opioid use to high-risk individuals who will be undergoing surgical procedures. This engagement may motivate people to discuss the need for and appropriate use of post-procedure opioids with their providers.
- Medical, social and behavioral factors can inform powerful predictive analytics and modeling. Through technology, it’s possible to identify individuals at a high or rising risk of opioid misuse and then develop care plans and behavioral science-backed engagement methods that can prevent addiction and other poor outcomes associated with opioid misuse. By proactively identifying high-risk individuals, providers can modify their patient education and prescribing behaviors appropriately.
- Cross-sector research can help identify the factors contributing to opioid addiction and identify effective treatment methods. Gainwell’s HMS, in collaboration with the Digital Health Cooperative Research Centre and Stanford University, is nearing the end of an opioid research initiative, for which HMS supplied a de-identified database of more than 2 million patients.
The human and economic costs of America’s opioid crisis are the result of a model where individuals are treated only after they’ve become addicted. To change this trajectory, the healthcare and public policy sectors instead must focus on preventing addiction and mitigating the risk factors associated with opioid misuse. The four recommendations outlined here can help clinicians and payers identify the medical, socioeconomic, behavioral and environmental factors that predispose people to opioid addiction and make targeted interventions before addiction occurs.